1) Do you have trouble understanding conversation in a noisy restaurant or crowded room?
o Yes o No o Sometimes
2) Do you sometimes feel that people are mumbling or not speaking clearly?
o Yes o No o Sometimes
3) Do you experience difficulty following dialog in the theater?
o Yes o No o Sometimes
4) Do you sometimes find it difficult to understand a speaker at a public meeting or a religious service?
o Yes o No o Sometimes
5) Do you find yourself asking people to speak up or repeat themselves?
o Yes o No o Sometimes
6) Do you find men’s voices easier to understand than women’s?
o Yes o No o Sometimes
6) Do you experience difficulty understanding soft or whispered speech?
o Yes o No o Sometimes
7) Do you have difficulty understanding speech on the telephone?
o Yes o No o Sometimes
8 ) Does a hearing problem cause you to feel embarrassed when meeting new people?
o Yes o No o Sometimes
9) Do you feel handicapped by a hearing problem?
o Yes o No o Sometimes
10 Does a hearing problem cause you to visit friends, relatives, or neighbors less often than you would like?
o Yes o No o Sometimes
11) Do you experience ringing or noises in your ears?
o Yes o No o Sometimes
12) Do you hear better with one ear than the other?
o Yes o No o Sometimes
13) Have you had any significant noise exposure during work, recreation, or military service?
o Yes o No
14) Have any of your relatives (by birth) had a hearing loss?
o Yes o No
Scoring
2 points for Yes
1 point for Sometimes
0 points for No
Scores of 3 or more: May mean that you have a hearing problem.
Scores of 6 or more: Strongly suggest that a hearing check is warranted.